Wilmington Eye Group, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4635 Issued in MA

Legal business name

WILMINGTON EYE GROUP, INC.

Practice address

229 Main St
Pearle Vision
Wilmington, MA 01887-2302

Phone

(978) 658-8890

NPI assigned

May 2, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Alex Russakovsky, O.D.NPI 1366634792

Title

President

Phone

(617) 285-4575

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alex Russakovsky, O.D.

  • Optometrist
  • Somerville, MA
  • NPI 1366634792
  Medicare reassignment NPD Authorized official
• Bich Van Thi Nguyen

  • Optometrist
  • Wilmington, MA
  • NPI 1457109001
  NPD
• Ken Chen

  • Optometrist
  • Alameda, CA
  • NPI 1346640976
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414022400000",
    "number": "1003226879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 MCGRATH HWY # 4",
            "address_2": "PEARLE VISION",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021434508",
            "telephone_number": "617-623-7522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "229 MAIN ST",
            "address_2": "PEARLE VISION",
            "city": "WILMINGTON",
            "state": "MA",
            "postal_code": "018872302",
            "telephone_number": "978-658-8890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILMINGTON EYE GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-02",
        "last_updated": "2014-10-23",
        "status": "A",
        "authorized_official_last_name": "RUSSAKOVSKY",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-285-4575",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MA",
            "license": "4635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brianne Whitmore, DPT
• Luke Wille
• Robert Patrick Williamson, MD
• Willow Brook Operator LLC
• Wilmington Dental Group, PC
• Wilmington Family Chiropractic and Wellness Center, Inc.
• Wilmington Family Counseling Service Inc
• Wilmington Family Dental
• Wilmington Family Dental PC
• Wilmington Pediatrics, Inc.

• Optometrist in Wilmington, MA
• Providers in Wilmington, MA by specialty
• Optometrist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.